Transcript Saudi arabia

Pad 601
Health Services & Hospitals
Administration
Dr. Hussein M Borie
[email protected]
‫ حسين محمد برعي‬/‫د‬
0555601637
H.M. BORIE
MANAGING
HEALTH
SERVICES
ORGANIZATIONS
By
Jonathon S. Rakich ,
B . B . Longest , &
Kurt Darr
H.M. BORIE
PAD 601
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Introduction about the course : Pad 601
* The contents : Parts 1 & 2 *
Management and managers (Ch.1)
Health Care Delivery Systems(Ch.2)
Concepts of Organization Design(Ch.3)
Health Services Organizations(Ch.4)
Health SERVICES Technology(Ch.6)
H.M. BORIE
Contents
 Organizational Change(Ch.12)
 PROBLEMS SOLVING & DECISIONS
MAKING(Ch.7)
 Health Services Strategic Planning( Ch.8)
 COMMUNICATION ( Ch.17)
Healthcare Systems
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Major Definitions
Conceptual Definitions
Operational Definitions
Healthcare Systems
Health and System Goals
International Health Care Systems
Comparative Health Care Systems
What Makes a Good Healthcare System
H.M. BORIE
HEALTH or HEALTHCARE
 Traditionally, health has been viewed as the
absence of disease, and healthcare as the
treatment and increasingly the prevention of
disease.
 In most countries, the traditional focus of the
Department of Health has been to manage illness
rather to achieve health.
 Health services alone do not determine human
health.
H.M. BORIE
What is Health ?
 Health is a complex and multidimensional
issue .
 Many of the factors influencing over all
health either not in the traditional domain of
health care or are difficult to influence , e.g.:
Water quality , diet , genetics , and
consumption of tobacco & other……..
H.M. BORIE
DEFINITION of WHO ?
 Health is a state of complete physical,
mental, and social well-being and not merely
the absence of disease or infirmity.
 Historically, all the great advances in health
have been caused by prevention of
diseases.
H.M. BORIE
What is HEATH CARE System?
The system Concept
A system is set of components that are related in
the accomplishment of some purpose.
In the study of healthcare administration, our
principal concern is healthcare systems ; that is ,
systems composed of human beings , money ,
materials , equipment , and so on , which are
related in the accomplishment of some goal , or
goals .
Healthcare systems are essentially social systems (
in the attitudes , perceptions , motivations , and
expectations of human beings ) .
H.M. BORIE
Components of Healthcare Systems
 Consist of a number of interrelated
subsystems .
 Each of these subsystems has a purpose
which, if attained, aids the larger system in
reaching its overall goals.
 For examples the healthcare systems of
U.S.A, Canada , Saudi Arabia, and other.
H.M. BORIE
Elements of Healthcare Systems
 Inputs ( human resources , material , technology ,
information , capital , …….
 Outputs ( patient care , acceptable costs , training
, other objectives ) .
 Process
 Feedback
 Outcome (improvement in infant mortality rate, life
expectancy at birth,…….)
H.M. BORIE
The Health Care Delivery System
 Functions through Complex interaction among:
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Government
Health Professionals
Consumers
Third party payers
Employers
Delivery Systems
 These groups use competition, standards, a
regulation to pursue a balance in their respective
health care goals of access, quality, and finance .
 There is no single source of governance or health
policy….
 It is an amalgamation of many different agendas
H.M. BORIE
The Canadian Health Care System
 The System is based on independent “Provincial
Care”
 Each Province has its own health insurance plan
 All provinces apply the following minimum federal
health criteria:
– Universal insurance coverage
– Comprehensive coverage (inpatient and outpatient
hospital)
– Portable coverage for residents who move to different
province
– Publicly operated on none profited basis
Comparison between Canadian and
American Health Care system
 Canadian
– Coverage: Universal
and comprehensive
– Access: No financial
Barriers
– Private insurance:
Small
– Payers model: single
– Cost control: High
and Centralized
– System capacity:
High degree of
control
 United States
– Coverage: Mixed: Medicare
and private
– Access: Financial Barriers
– Private insurance: Large
– Payers model: multiple
– Cost control: Low and
fragmented
– System capacity: Low
degree of control
**U.S.A**
 Total population: 298,213,000
 GDP per capita :(Intl $, 2004) 39,901
 Life expectancy at birth m / f ( years ) 75.0/80.0
 Healthy life expectancy at birth m / f ( years, 2002 ) 67.2/71.3
 Child mortality m / f ( per 1000 ) 8/7
 Adult mortality m / f ( per 1000 ) 137/81
 Total health expenditure per capita ( Intl $, 2003 ) 5,711
 Total health expenditure as % of GDP ( 2003 ) 15.2
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**WHO REPORT 2006**
*Saudi Arabia*
 Total population : 24,573,000
 GDP per capita ( Intl $, 2004 ) 15,307
 Life expectancy at birth m / f ( years ) 68.0/74.0
 Healthy life expectancy at birth m / f ( years, 2002 ) 59.8/62.9
 Child mortality m / f ( per 1000 ) 29/24
 Adult mortality m / f ( per 1000 ) 196/120
 Total health expenditure per capita ( Intl $, 2003 ) 578
 Total health expenditure as % of GDP ( 2003 ) 4.0
 *WHO REPORT 2006 *
H.M. BORIE
EGYPT*
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Total population: 74,033,000
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GDP per capita ( Intl $, 2004 ) 4,274
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Life expectancy at birth m / f ( years ) 66.0/70.0
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Healthy life expectancy at birth m / f ( years, 2002 ) 57.8/60.2
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Child mortality m / f ( per 1000 ) 36/36
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Adult mortality m / f ( per 1000 ) 239/158
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Total health expenditure per capita ( Intl $, 2003 ) 235
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Total health expenditure as % of GDP ( 2003 ) 5.8
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WHO REPORT 2006*
H.M. BORIE
POPULATION
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* The force-field and well-being paradigms of health. (from Blum. Henrik K.
Expanding health care horizons: From a general systems concept of health to a
national health policy. 2d ed., 37. Oakland, CA: Third Party publishing Company.
1983: reprinted by permission.)
* Blum suggests golas for the health system:
- prolonging life and preventing premature death;
- minimizing departures from physiological or function norms by focusing attcntion
on prccurors of illness;
- minimizing discomfort (illness):
- minimizing disability (incapacity):
- promoting high-level “wellness” or self-fulfillment:
- promoting high-level satisfaction with the environment;
- extending resistance to ill health and creating reserve capacity: and
- increasing opportunities for consumers to participate in health matters.
Education of Managers
The University of Chicago
established the first master's degree
program in 1934. now it is the
American College of Healthcare
Executive (ACHE).
H.M. BORIE
About 60 graduate programs were
accredited by the Accrediting
Commission on Education for a
professional Health Services
Administration .
H.M. BORIE
United States master's degree
programs have more than 25,000
graduates .
H.M. BORIE
Educational programs provide a
generic education in health
services, rather than hospital,
management . Some offer specialty
preparation in hospital, nursing
facility, or ambulatory services
management.
H.M. BORIE
The didactic portion for accredited
programs is two academic years; 4
Semesters. Most programs include
field experiences of varying
lengths. Many require a 1-year
residency that allows application of
the academic preparation under the
guidance of an On-Site preceptor.
H.M. BORIE
The most common educational
preparation for HSO managers is
the master degree.
H.M. BORIE
The basic curriculum in accredited
health services management
graduate programs covers eight
areas: -
H.M. BORIE
1
Assessment and understanding of
health status of populations;
determinants of health and illness;
and factors influencing the use of
health services.
H.M. BORIE
2
Understanding of the organization,
financing and delivery of health
services, drawing on the social
science disciplines ( economics,
law, political science, physiology,
sociology, and related disciplines).
H.M. BORIE
3
Understanding of, and
development of skills in, economic,
financial, policy, and quantitative
analysis.
H.M. BORIE
4
Understanding of the values and
ethical issue associated with the
practice of health services
administration, and the
development of skills in ethical
analysis.
H.M. BORIE
5
Understanding of, and development
of skills in, positioning
organizations favourably in the
environment and managing these
organizations for continued
effectiveness.
H.M. BORIE
6
Provision of opportunities for
development of leadership potential
including stimulating creativity,
and interpersonal and
communication skill development.
H.M. BORIE
7
Understanding of, and development
of skills in, the management of
human, capital, and information
resources.
H.M. BORIE
8
Understanding of, and development
of skills in, evaluation methods to
assess organisational performance
and, in particular; methods to
assure the quality of services
provided.
H.M. BORIE
AS with the graduate programs,
rapid growth in the number of
undergraduate programs preparing
health services management
personnel occurred its the late
1960s and early 1970s.
H.M. BORIE
Master programs prepare graduates
to become senior-level line or staff
managers; baccalaureate programs
train middle-level supervisors or
department managers.
H.M. BORIE
Managers in other types of HSOs
are unlikely to be licensed. A state
regulatory arm is exercised when
problems suggest that a profession's
self-regulation and self-discipline
are ineffective and the state must
act to protect the public.
H.M. BORIE
Licensure, Certification, and
Registration of Caregivers
 Licensure: a process performed by
government that allows someone to engage
in an occupation after finding that the
applicant has achieved a certain minimum
competency . Physicians and dentists are
always licensed, for example .
 Registration: qualified individuals are listed
on an official roster maintain by government
or nongovernmental body (registered nurse)
CERTIFACTIN
 A process by which a nongovernmental
agency or association grants recognition to
someone who meets its qualification
(Nurses-midwives are certified for example).
 Physicians
 Nonphysician Caregivers : Dentists,
Physician Assistant, Pharmacists,
Technologists, & other .
PROBLEMS & ISSUES OF
PERSONNEL
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SHORTAGES
MALDISTRIBUTION
IMMIGRATION & FMGs
HEALTHCARE EDUCATION
Diagnostics- Related Groups
CON, UR, PSROs, and PROs
POPULATION
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* The force-field and well-being paradigms of health. (from Blum. Henrik K.
Expanding health care horizons: From a general systems concept of health to a
national health policy. 2d ed., 37. Oakland, CA: Third Party publishing Company.
1983: reprinted by permission.)
* Blum suggests golas for the health system:
- prolonging life and preventing premature death;
- minimizing departures from physiological or function norms by focusing attcntion
on prccurors of illness;
- minimizing discomfort (illness):
- minimizing disability (incapacity):
- promoting high-level “wellness” or self-fulfillment:
- promoting high-level satisfaction with the environment;
- extending resistance to ill health and creating reserve capacity: and
- increasing opportunities for consumers to participate in health matters.
‫اداره التامين الصحي‪PAD376:‬‬
‫د‪ /‬حسين برعي‬
‫تجارب بعض الدول الصناعيه المتقدمه‪ :‬‬
‫‪ )1‬الواليات المتحده االمريكيه ‪‬‬
‫مقدمه عن الرعايه الصحيه االمريكيه ‪‬‬
‫دور الحكومه في الرعايه الصحيه والتامين الصحي ‪‬‬
‫‪ ( 1‬برامج التامين الصحيه الحكوميه‪ :‬‬
‫ميديكير وميديكيد ‪MEDICARE & MEDICAID‬‬
‫تامين االطفال والمجاربين القدامى‬
‫رقم ورمز المادة ‪376 PAD‬‬
‫اسم المادة‪ :‬اداره تامين صحي‬
‫‪:‬رقم ورمز المادة ‪376 PAD‬‬
‫الفصل الدراسي ‪:‬الثاني‬
‫العام الدراسي ‪1427/1428:‬هـ‬
‫أستاذ المادة ‪ :‬د‪ /‬حسين بن محمد برعي‬
‫‪:‬االداره العامه ‪ 4.102-‬رقم المكتب‬
‫‪ / 6952000‬هاتف المكتب‪/:‬تحويله‪65529:‬‬
‫الجوال ‪0555601637 :‬‬
‫‪[email protected]‬‬
‫‪:‬البريد اإللكتروني‬
‫) ص‪.‬ب ‪ 1:00—12:00 ،‬ظهرا ) االحد ‪ ,‬الثالثاء ‪ 9:30 --‬الساعات المكتبية‪8:30 :‬‬
‫عصرا ‪5:00---2:15‬‬
‫))االحد ‪ ،‬الثالثاء‪،‬االربعاء‪،‬‬
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PAD376:‫اداره التامين الصحي‬
‫ حسين برعي‬/‫د‬
 ‫ الرعايه الصحيه المداره‬MANAGED CARE:(2
 ‫ الصحه‬/‫الحفاظ على‬/ ‫ منظمات صيانه‬:HMOs
Health Maintenance Organizations
 ‫منظمات الرعايه المفضله‬: PPOs
 Preferred Provider Organizations
 PRIVATE HEALTH INSRANCE (3
 ‫ ( التامين الصحي الخاص‬3
‫‪PAD475‬‬
‫المراجعه‬
‫‪ )1‬السياسات الصحيه‪ :‬التعاريف ‪ ،‬المفاهيم ‪ ،‬النظريات ‪ ،‬االدله ‪‬‬
‫والتطبيقات على النظام الصحي السعودي‪.‬‬
‫‪ ) 2‬الفعاليه‪،‬الكفاءه‪،‬االنصاف‪:‬التعاريف‪،‬المفاهيم‪،‬االمثله ‪‬‬
‫والتطبيقات‪:‬الفصل ‪2‬و‪4‬و‪ 6‬من الكتاب المقرر‪.‬‬
‫‪ )3‬النظام الصحي السعودي ‪ :‬ويشمل نظام الضمان الصحي ‪‬‬
‫التعاوني ‪ ،‬نظام مزاوله الطب البشري القديم ونظام مزاوله‬
‫المهن الصحيه الجديد ‪ ،‬ونظام المؤسسات الصحيه الخاصه‬
‫)مراجعه االنظمه الصحيه والموجوده في المكتبه وعلى‬
‫االنترنت )‪.‬‬
‫رقم ورمز المادة ‪376 PAD‬‬
‫رقم ورمز المادة ‪376 PAD‬‬
‫اداره التامين الصحي )‪)1428-2/1427‬‬
‫استاذ الماده‪ :‬د‪ /‬حسين برعي‬
‫‪[email protected]‬‬
‫الجوال ‪0555601637‬‬
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‫‪PAD475‬‬
‫امثله وتطبيقات‬
‫ما هي السياسه الصحيه؟ تعاريفها وامثله على ذلك‪ .‬‬
‫ماالفرق بين الصحه والرعايه الصحيه؟ ‪‬‬
‫ما اهم مؤثرات المستوى الصحي للسكان؟ معدالت الوفاه العامه ‪ ،‬وفاه االطفال ‪‬‬
‫الرضع‪ ،‬والحياه المتوقعه ‪،‬وانتشار االمراض‪.‬‬
‫‪ .‬‬
‫تعاريف الفعاليه والكفاءه واالنصاف نظريا وتطبيقيا‬
‫تعاريف النظام الصحي ‪ ،‬اهداف االنطمه الصحيه ‪،‬عناصر النظام الصحي ‪‬‬
‫‪،‬المؤثرات التي يتم بموجبها تقييم االنظمه الصحيه ‪.‬‬
‫خصائص نظام الرعايه الصحيه في المملكه ؟ ‪‬‬
‫مؤثرات قصور النظام الصحي السعودي وكيف يتم تطوير النظام الصحي؟ ‪‬‬
‫خصائص نظام الرعايه الصحيه في المملكه ‪ :‬االنظمه الصحيه المتعلقه بالمؤسسات ‪‬‬
‫الصحيه الخاصه وبمزاوله المهن الصحيه وبالضمان الصحي التعاوني‬
PAD 475
‫المصطلحات الصحيه‬
 cost benefit analysis )
(
. efficiency
(
.
)cost effectiveness analysis
 universal health insurance
 predisposing and enabeling factors )need and utilization ‫عربيا هو‬
)
(group health insurance, independent practice association
 HMOs/health maintenance organizations , PPOs ,

‫) معنى‬equal opportunity)
(
.
 DIAGNOSTIC RELATED GROUPS (DRGs)
 ,
EFFICIENCY , EFFECTIVENESS ,
EQUITY
 MEDICARE , MEDICAID ,coinsurance ,deductibles
 Micromanagement, macromanagement , capitation,
 ENTITLEMENT , EGALITARIAN , CONTRACTARIAN ,Needs-Based
 Utilitarian, Freedom of Choice